Gary Mendese

IMP3 predicts aggressive superficial urothelial carcinoma of the bladder

Purpose: In this study, we investigated whether an oncofetal protein, IMP3, can serve as a new biomarker to predict progression and metastasis of early-stage urothelial carcinoma of the bladder. Experimental Design: The expression of IMP3 in 242 patients with primary superficial bladder urothelial carcinoma and metastatic urothelial carcinoma was evaluated by immunohistochemistry. Patients with primary superficial urothelial carcinoma of the bladder were further investigated by use of survival analysis. Results: Twenty percent (42 of 214) of primary superficial urothelial carcinomas and 93% (26 of 28) of metastatic urothelial carcinomas expressed IMP3. Kaplan-Meier plots and log-rank tests showed that patients with IMP3-positive tumors had a much lower progression-free survival (P = 0.0002) and disease-free survival rate (P = 0.0067) than did those with IMP3-negative tumors. The 5-year progression-free and disease-free survival rates were 91% and 94% in IMP3-negative patients versus 64% and 76% in IMP3-positive patients, respectively. Sixty percent of IMP3-positive patients with superficial invasive urothelial carcinoma at initial diagnosis went on to develop metastases, whereas no metastasis was found in IMP3-negative patients (P = 0.0017). In the multivariable Cox analysis, patients with IMP3 expression in their superficial urothelial carcinomas subsequently developed invasive tumors or metastasis at a rate that was about five times greater than cases without expression of IMP3 adjusting for other well-known clinical variables (tumor stage and grade, etc.). Conclusions: Our findings indicate that IMP3 is an independent prognostic marker that can identify a group of patients with a high potential to develop progression and who might benefit from early aggressive therapy.

Histopathology of Gottron's papules--utility in diagnosing dermatomyositis.

Dermatomyositis (DM) is an uncommon connective tissue disease that presents with a characteristic violaceous skin eruption as well as proximal muscle weakness, primarily of the upper extremities. Cutaneous stigmata of DM include Gottron’s papules, similarly colored papules and plaques overlying the extensor surfaces of finger joints. While biopsy of the typical poikilodermatous skin eruption found in patients with suspected DM is a standard algorithmic component in the workup and diagnosis of the disease, Gottron’s papules are rarely sampled for histopathologic assessment. The precise reason for this is not known but may be related to problems associated with healing because of constant motion forces in the vicinity of the joint. Given this, sparse literature is available on the histopathologic features of Gottron’s papules. In this study, we present two cases in which the presence of papular (Gottron’s papules) lesions on the fingers led to a presumptive diagnosis of DM and prompted biopsies of the same. The study illustrates the diagnostic utility of biopsies from Gottron’s papules.

Pagetoid reticulosis in a prepubescent boy successfully treated with photodynamic therapy.

Pagetoid reticulosis or Woringer–Kolopp disease (WKD) is a rare variant of mycosis fungoides, consisting of localized patches or plaques containing intraepidermal proliferations of neoplastic T cells in a pagetoid distribution (similar to that of the adenocarcinomatous cells found in Paget disease of the nipple), which typically affects middle‐aged and elderly men. We report a trial of photodynamic therapy (PDT) with topical aminolaevulinic acid (ALA), carried out on a 10‐year‐old boy with a solitary lesion of WKD on his foot, to avoid the long‐term problems associated with the typical treatments for WKD of surgery and/or local irradiation. The plaque progressively flattened during treatment, and after nine PDT sessions over 13 months, the patient was clinically free of disease. PDT may be a viable alternative to surgery and local irradiation for localized cutaneous T‐cell lymphoma, including WKD, especially in younger patients.

To scoop or not to scoop: the diagnostic and therapeutic utility of the scoop-shave biopsy for pigmented lesions.

BACKGROUND Concern over transection of melanomas has inhibited many practitioners from using the scoop-shave for removal of pigmented lesions. OBJECTIVE To assess the safety and efficacy of the scoop-shave for pigmented lesions. MATERIALS AND METHODS The practitioners clinical diagnosis, intent (sample or completely remove), and removal technique (excision, punch, shave biopsy, or scoop-shave) were recorded. Pathology results including the status of the peripheral and deep margins were subsequently documented. RESULTS Over an 8-month period, 333 procedures were performed. Of the 11 melanomas (6 in situ and 5 invasive) removed by the scoop-shave, none had positive deep margins and 6 (2 in situ and 4 invasive) were completely removed. One of the 50 dysplastic nevi removed by scoop-shave had a positive deep margin (moderately dysplastic). Forty-six dysplastic nevi were completely removed by the scoop-shave. When the practitioners intent was “complete removal,” the lesion was completely removed 73.1% of the time by scoop-shave, 91% by standard excision, 18.1% by shave biopsy, and 78.6% by punch excision (p < .0001). CONCLUSION The scoop-shave is a safe and effective technique for diagnosis and treatment of melanocytic lesions.

Using an absorbable purse-string suture to reduce surgical defects of the nose before placement of full-thickness skin grafts.

thickness nasal ala defects with a technique that uses both a partial-thickness auricular cartilage complex graft and a nasolabial flap. The curved contour of the auricular cartilage is similar to that of the nostril, which makes it a good donor for ala reconstruction. The nasolabial flap was able to provide an abundant blood supply to nourish the cartilage complex graft, and thereby keep the entire reconstructed ala alive. In the only case with partial flap necrosis, the patient was a heavy smoker before the operation and continued to smoke postoperatively against the advice, which may have negatively influenced the blood supply to the flap, contributing to necrosis. In addition, the partial-thickness auricular cartilage complex grafts can restore the lining and cartilage simultaneously. Although the cartilage graft contains 2 layers, its thickness is still relatively thin. This important feature eliminates the need for another ancillary operation to debulk and recontour the transplanted graft.

Selected Indoor Tanning Myths and Controversies

In the face of increasing evidence that indoor tanning is harmful, tanning enthusiasts and the tanning industry defend the practice on several grounds. The principal argument offered in defense of year-round tanning is the claimed health benefit of high levels of vitamin D, also called the sunshine vitamin, which is made in skin following UV irradiation. However, vitamin D is readily available as an oral supplement; and oral vitamin D obviates the needed exposure to UV light that also leads to photoaging and skin cancer. Further, the claimed health benefits of high vitamin D levels are unproven. A second myth, that indoor tanning is safer than sun tanning ignores the fact that tanning is a well-established DNA damage response, achieved in proportion to DNA damage, regardless of the exact wavelengths emitted by tanning bulbs or by the sun. Similarly, obtaining a “base tan” before a planned sunny vacation will not decrease cumulative UV damage. Finally, indoor tanning may be occasionally an effective, more convenient and less expensive alternative to physician-supervised phototherapy for patients with UV-responsive skin disease, but for most patients professional staff and medical light sources with specific spectral output established as optimal for their disease provide far superior safety and efficacy.

Concomitant Merkel Cell Carcinoma and Basal Cell Carcinoma Presenting as a Solitary Nodule

We report a case of a concomitant basal cell carcinoma (BCC) and Merkel cell carcinoma (MCC) presenting as a solitary tumor. Despite the rarity of MCC in general, the tumor has been reported to occur synchronously with numerous malignancies, including chronic lymphocytic leukemia, dermatofibrosarcoma protuberans, melanoma, squamous cell carcinoma (SCC), and sebaceous carcinoma. There is also a report of a large, ill-defined, ulcerated MCC containing foci of SCC and BCC. To our knowledge, this is only the second report of concomitant BCC and MCC and the only case identified in a single, clearly defined tumor.